RH Reality Check » Congressional hearing on ab-onlyhttp://rhrealitycheck.org
News, commentary and analysis for reproductive and sexual health and justice.Tue, 03 Mar 2015 18:01:49 +0000en-UShourly1http://wordpress.org/?v=4.1.1Ab-Only: Where Do We Go From Here?http://rhrealitycheck.org/article/2008/04/30/ab-only-where-do-we-go-from-here/?utm_source=rss&utm_medium=rss&utm_campaign=ab-only-where-do-we-go-from-here
http://rhrealitycheck.org/article/2008/04/30/ab-only-where-do-we-go-from-here/#commentsWed, 30 Apr 2008 08:45:21 +0000The time has come for the Democrats to correct course and stop government funding of ineffective abstinence-only programs. How can congressional leaders continue to ignore the public health consensus about science-based programs?

]]>Last Wednesday, Congressman Henry Waxman (D-CA), Chair of the House Committee on Oversight and Government Reform, conducted the first-ever hearing on the effectiveness of abstinence-only-until-marriage programs. It took 12 years of conservative congressional leadership and $1.5 billion before we finally achieved some public accountability for these failed programs.

Congressman Waxman deserves a great deal of credit, and our thanks, for focusing congressional attention on the biggest ideological boondoggle of the last 50 years. His committee reports have been pivotal in focusing the public's attention on the problems inherent in these programs.

The spotlight, and pressure, now clearly shifts to the House Democratic leadership to act. After the overwhelming evidence highlighting the ineffectiveness of abstinence-only programs presented at last week's hearing, Congress cannot replay last year's debacle when Chairman David Obey pushed to increase funding for these failed programs by $28 million.

The hearing produced a litany of rejection of abstinence-only programs from mainstream, science-based public health organizations. The American Academy of Pediatrics testified that the abstinence-only approach was not only ineffective, but could cause real harm to young people. The Institute of Medicine stated that continued support for these programs does not "comport with the evidence" and no reason existed to hamstring federal interventions by placing them in the abstinence-only straight-jacket. The American Public Health Association also rejected abstinence-only programs and cited the significance of 17 states rejecting abstinence-only dollars in the face of the enormous need for public health resources at the state level.

Supporters of abstinence-only programs tried to muddy the waters by constantly referring to a discredited Heritage Foundation report claiming that abstinence-only programs work and that the federal government spends more money on comprehensive sex education programs than on abstinence-only programs. They also turned to one of their favorite researchers, Stan Weed, whose study of a Virginia abstinence-only program raised more concerns than it addressed. Weed's support staff at the hearing included Valerie Huber, the chief lobbyist for the National Abstinence Education Association, an organization known for its misleading and inaccurate information about sex education.

Fortunately, Dr. John Santelli from Columbia University's Mailman School of Public Health (and a former high-ranking CDC official in the field of teen pregnancy prevention) summed it all up by explaining that abstinence has a legitimate role within comprehensive sex education which also includes birth control and condoms. However, abstinence-only programs that exclude information about birth control and condoms, have no place at the center of federal sex education policy.

So where do we go from here?

The time has come for the Democrats to correct course and stop government funding of ineffective abstinence-only programs. With the teen birth rate on the rise, with one in four teen girls contracting an STD, with 55 young people getting HIV every single day, how can congressional leaders continue to ignore the public health consensus about science-based programs?

If we listen to the experts from last week, the path for Democratic leaders is clear — it's time to support what works. All the data, the studies, and the logic, point to one conclusion — a comprehensive approach to sex education that includes birth control and condoms, as well as abstinence, works.

So, no more excuses. It's time to protect the health and lives of America's youth in the era of AIDS.

]]>http://rhrealitycheck.org/article/2008/04/30/ab-only-where-do-we-go-from-here/feed/2Hearing Highlights Ab-Only Industry In Perilhttp://rhrealitycheck.org/article/2008/04/30/hearing-highlights-ab-only-industry-in-peril/?utm_source=rss&utm_medium=rss&utm_campaign=hearing-highlights-ab-only-industry-in-peril
http://rhrealitycheck.org/article/2008/04/30/hearing-highlights-ab-only-industry-in-peril/#commentsWed, 30 Apr 2008 08:42:21 +0000Both the members of Congress and the lone public health researcher who spoke in support of abstinence-only at the recent Congressional hearing were scrambling for evidence.

]]>Last Wednesday, Congress held the first ever oversight hearing on the abstinence-only-until-marriage industry. It's about time. These programs have been around for over a quarter century and consumed nearly $2 billion in federal and state tax dollars. After all the grousing about the bias of the hearing from the right wingers who support the abstinence-only-until-marriage approach, one might ask: If the programs are so great, why did the Republicans never hold similar hearings to champion their success? The answer: It would have been laughable.

And so it was last week when one lone researcher working from his home-based "institute" tried to outwit the major public health institutions of our country. By his own words, Stan Weed, the only witness last week suggested by the Republican minority to scientifically defend the Bush administration's funneling of billions to their favored kin, has spent more than 20 years working on these issues, interviewed more than 500,000 teens, and studied more than 100 abstinence-only programs. Okay, it sounds impressive, right? Until you learn, that after all that bluster, Weed has just one – ONE – peer reviewed and published study in a refereed journal showing abstinence-only-until-marriage programs can have a modest impact among seventh graders in delaying sex. And with that, Weed urged – straight-faced – to continue the gravy train that is the abstinence-only-until-marriage industry.

It should also be noted that Weed's guest on his back-up chair while testifying was not an assistant at his "institute" or some other public health professional. It was the head of the National Abstinence Education Association, the abstinence-only-until-marriage industry's lobbying arm, Valerie Huber. For what purpose did the researcher need the hired gun lobbyist at his side? Her presence stretched the credibility of Weed's objectivity, to say the least.

On the side of public health evidence, however, were the Institute of Medicine, the American Academy of Pediatrics, the American Public Health Association, the Society for Adolescent Medicine and many others. All concurred that more than a decade worth of research demonstrates that abstinence-only-until-marriage programs are not working and a change in course is long overdue.

The clear imbalance left some right-wing Congressional Members scrambling during the hearing.

Representative Mark Souder (R-IN), one of the most extreme right wing lawmakers in the Congress, praised Weed – the man with thread-bare credentials who works out of his home – as the lone voice of sound public health in the room. As for the real luminaries at the witness table with Weed, Souder charged all of them with advancing ideological positions. He might as well have decried the entire thing a vast left wing conspiracy among the protectors of our public health and left the room.

Representative John Duncan, a Republican from Tennessee, said it was "rather elitist" that those with public health degrees thought they knew better than parents what type of sex education works. Well, yes, Mr. Duncan, isn't that why we fund and support public health as a vocation – to assist individuals, parents and families in promoting good health practices? And isn't this why the Congressional Committee on Oversight and Government Reform on which you sit, has jurisdiction over health programs and spending? The entire purpose is to consult those who actually "know" in order to arrive at informed decisions instead of opinions formulated from ignorance. One can reject their findings – as Mr. Duncan did – but it ought to be done honestly and with full confession for a "science-be-damned" mentality.

Duncan and Souder however, were left with little else to rely on. The evidence is in and the programs were finally called to account for the boon they've experienced at the taxpayer's expense. In desperate times, people do desperate things and Duncan and Souder were headed down that sad road.

For those present at the hearing, there was no more desperate a sign of the abstinence-only-until-marriage industry's questionable future than Heritage Foundation's Robert Rector's attempts at spin. Rector, credited as the architect of the state grants through Title V to pay for abstinence-only-until-marriage programs, tried valiantly to stave off the hearing's impact. The day prior, he and another colleague at Heritage, attempted some up-front spin by assembling and regurgitating previous so-called "evidence" to support their position. At the close of the hearing, a crest-fallen and clearly annoyed Rector was observed to be expressing his deep displeasure to Representative Souder for apparently failing to carry the Heritage Foundation's banner. It almost made me feel sorry for Souder. Almost. Perhaps I actually would have if Souder had not earlier told the two youth witnesses on the panel – one of whom acquired HIV due to abstinence-only-until-marriage instruction – that they were irrelevant to the purpose of the hearing. Far from laughable, this was downright appalling.

What was most miraculous at the hearing was just how much had been conceded by the supporters of abstinence-only-until-marriage programs. Next week, I'll be writing about this in terms of the key pieces of good news that emerged from the Congressional hearing and will answer the most consistent question I've gotten since the hearing: So what does this mean? I assure you, it was a lot more than just words that came out of last week.

]]>http://rhrealitycheck.org/article/2008/04/30/hearing-highlights-ab-only-industry-in-peril/feed/7Hearings Assess the “Only” in Abstinence-Onlyhttp://rhrealitycheck.org/article/2008/04/29/hearings-assess-the-only-in-abstinence-only/?utm_source=rss&utm_medium=rss&utm_campaign=hearings-assess-the-only-in-abstinence-only
http://rhrealitycheck.org/article/2008/04/29/hearings-assess-the-only-in-abstinence-only/#commentsTue, 29 Apr 2008 08:42:21 +0000A congressional hearing Wednesday by the House oversight committee that promised to "assess the evidence" on abstinence-only demonstrated that social conservatives still shape the public debate on sexuality education.

]]>A congressional hearing Wednesday by the House oversight committee promised to "assess the evidence" on abstinence-only sex education.

That evidence includes two independent reports that abstinence-only programs have no effect on teenage sexual activity and do not meet a basic scientific standard. These studies have led to a growing momentum in Congress to eliminate abstinence-only funding.

But instead of analyzing these studies, a four-hour hearing by the House Committee on Oversight and Government Reform rarely moved beyond championing the value of pre-marital abstinence. The discussion played into the central tenant of abstinence-only education: only abstinence, not condoms or contraception, can prevent sexually transmitted diseases and unwanted pregnancies.

The hearing showed that social conservatives continue to shape the public debate on this. Abstinence-only education, one plank of Newt Gingrich's 1994 "Contract With America," is now a big part of the Bush administration's public-health agenda, receiving $1.3 billion since 1997. Despite the current calls to end funding, the conservatives who framed the abstinence-only policy have created a formidable obstacle for opponents to overcome.

"It's going to be hard to make inroads," said Heather Boonstar, a senior fellow at the Guttmacher Public Policy Institute, an organization that conducts sexual health research. "Social conservatives are going to fight it tooth and nail."

The oversight hearing looked like the next step toward ending a program that only discusses condoms and contraception in terms of their failure rates, and teaches, "A mutually faithful monogamous relationship in the context of marriage is the expected standard of sexual activity."

The effort to end it gained steam after a 2006 Government Accountability Office report on abstinence-only programs, funded by the federal government's Dept. of Health and Human Services. GAO, an auditing arm of Congress, found that the programs were exempt from the HHS's usual requirement that its programs must give medically accurate information about condoms. In addition, the three abstinence programs studied weren't producing clear results and lacked any self-evaluation for success.

Last April, the Dept. of Health and Human Services-funded Mathematica Policy Research Group did its own evaluation of abstinence education. Beginning in 1997, when the federal government first gave states a total of $50 million toward abstinence-only education, Mathematica researchers followed students in four abstinence-only programs. They found that "abstinence-only programs had no effect on the sexual abstinence of youth."

Since Mathematica's findings, 17 states have said no to federal abstinence-only money. "Forty-two percent of teens now live in states that have turned down funding," Guttmacher said.

But the $50 million to state government's is only part of the $176 million in this year's federal budget for abstinence-only education. Of that money, $113 million is federal grants given directly to Community Based Abstinence Education, or CBAE, programs.

Following the reports, congressional Democrats have pushed to eliminate this money. But Rep. David Obey (D-Wis.), chairman of the House Appropriations Committee, kept the program in this year's health spending bill, saying it would make President George W. Bush less inclined to veto programs Democrats wanted — like reproductive health clinics. "Abstinence-only was in jeopardy," said Ron Haskins, co-director of the Brookings Institution Center on Children and Families. "But Obey cut a deal."

Last month, 76 House members wrote to Obey, urging him to expend political capital on eliminating the state and CBAE programs from next year's budget. "Our tax dollars should be used to fund programs that benefit the public good," wrote Rep. James Moran (D-Va.), "not on unsuccessful, ideologically driven boondoggles."

A group of legislators, including Rep. Christopher Shays (R-Conn.), have introduced the Responsible Education About Life or REAL Act. It would move abstinence-only education dollars to abstinence-plus, or comprehensive sex-education. These would emphasize that abstinence is the sure way to prevent STD's and pregnancy, but would also explain the use of condoms and other contraceptives.

Shays, the last New England white shoe Republican in the House, tried to explain his position on Wednesday. "Sometimes I think we're trying to repeal the laws of gravity here," Shays said Wednesday. "There are natural instincts that young people will have and the REAL Act provides medically accurate information about both safe sex and contraception."

But despite the reports and the shifting political winds, his GOP colleagues refused to see the debate as one about medical accuracy. "This is a deep disagreement among competing values," said Rep. Mark Souder (R-Ind.). "Abstinence-only education is the only holistic approach to teach about the distressing elements of premarital sex."

Rather than ignore these emotional appeals, comprehensive sex-education proponents spent much of the hearing trying to prove they are pro-abstinence. "There is a broad consensus," Rep. Henry A. Waxman, the committee chairman, said in his opening statement, "that the benefits of abstinence should be part of any sex-education effort."

The concession that the federal government should value abstinence seemed to enable conservatives to stick with their tried-and-true logic. "There is no more scientific fact," said Rep. Virginia Foxx (R-N.C.), "that abstinence is the only way to prevent STD's and pregnancy."

Foxx and other social conservative's uncompromising stance gained traction in 1994, when the Republicans took control of Congress. Gingrich, as House Speaker, emphasized abstinence-only laws as a way to reduce the number of out-of-wedlock teenage mothers. The Republican Congress slipped $50 million for abstinence education into the 1996 Welfare Reform Act, after the bill had passed the House and Senate.

The provision laid out clear eight-point or "A-H" guidelines of what must be taught in order to receive funding. These include assertions like, "Sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects."

Abstinence funding increased by $13 million in 1999, when Congress created the CBAE federal grants. The grants then grew exponentially under the Bush administration, going from $20 million in 2001, to its current level of $113 million in 2005.

Marcella Howell, a vice-president for Advocates for Youth, a nonprofit organization devoted to sex education, said abstinence education was an early priority of Bush's social agenda. "He kept saying during the 2000 presidential campaign he was going to triple abstinence funding," Howell said. "It was a component of his faith-based initiatives."

With Bush on his way out, Howell said that prioritizing abstinence education might be as well. "Democrats on the appropriations committee may feel enough pressure to eliminate the program," Howell said. But Howell added that for the funding to end, the debate must shift away from conservative ideology and toward accurate information.

On Wednesday, Rep. Jack Welch (D-Mass.) offered a brief glimpse of one such discussion. "The GAO when they do this report is a neutral arbiter," Welch said. "And the GAO has concluded these abstinence-only programs are not achieving results."

]]>http://rhrealitycheck.org/article/2008/04/29/hearings-assess-the-only-in-abstinence-only/feed/2Committee Hears Impacts of Ab-Onlyhttp://rhrealitycheck.org/article/2008/04/25/committee-hears-impacts-of-ab-only/?utm_source=rss&utm_medium=rss&utm_campaign=committee-hears-impacts-of-ab-only
http://rhrealitycheck.org/article/2008/04/25/committee-hears-impacts-of-ab-only/#commentsFri, 25 Apr 2008 08:55:29 +0000On Wednesday, for the first time, a Congressional committee heard public health experts and young people testify about the effects of abstinence-only programs.

]]>On Wednesday, for the first time, a congressional committee took on the task of examining the $1.5 billion failure of government-funded abstinence-only programs. House Oversight and Government Reform Chairman Henry A. Waxman (D-CA-30) called on public health experts and young people whose lives have been deeply affected by the ineffective programs to urge lawmakers to reconsider the abysmally poor use of taxpayer dollars.

At this point, the weight of the evidence cannot be ignored, and under the glare of a congressional inquiry policymakers will have to answer tough questions about why we continue to waste millions of dollars a year on a policy that has failed to keep teens healthy and safe.

In addition, public health expert John Santelli, M.D., M.P.H., testified before the committee about numerous independent studies, including federally funded evaluations, that have concluded that abstinence-only programs do nothing to delay teenage sexual activity and do not adequately prepare young people to make responsible health decisions.

Recently, the CDC found that at least one in four teen girls has a sexually transmitted infection (STI), and that the teen birthrate is on the rise for the first time in 16 years.

The moving testimony by the two young people who shared their personal stories exposes the stark reality that abstinence-only programs are failing our teens. It's time to put our money toward real solutions that will help prevent sexually transmitted infections and unintended pregnancies among teenagers.

To date, 17 states have refused to accept federal funds for abstinence-only programs.

Planned Parenthood is a leading advocate for school education programs that will keep teens healthy – by including information about abstinence as well as about contraception, healthy communication, responsible decision making, and prevention of sexually transmitted infections.

Planned Parenthood has the nation's largest network of sex educators, who teach young people in schools and communities nationwide, every day, how to protect themselves from unintended pregnancy and sexually transmitted infections, including HIV/AIDS.

In our affiliates' 860 health centers across the country, our providers and educators see firsthand the price that young people pay when they are denied access to medically accurate, comprehensive sex education that could help them protect their lives and their futures. That's why today we submitted a statement for the Congressional Record urging Congress to work with those of us in the reproductive health community to find commonsense solutions to put an end to this public health crisis.

]]>http://rhrealitycheck.org/article/2008/04/25/committee-hears-impacts-of-ab-only/feed/0How Ab-Only Changed My Life: Testifying To Congresshttp://rhrealitycheck.org/article/2008/04/24/how-ab-only-changed-my-life-testifying-to-congress/?utm_source=rss&utm_medium=rss&utm_campaign=how-ab-only-changed-my-life-testifying-to-congress
http://rhrealitycheck.org/article/2008/04/24/how-ab-only-changed-my-life-testifying-to-congress/#commentsThu, 24 Apr 2008 08:40:04 +0000Max Siegel is 23 years old and has been living with HIV since he was diagnosed at 17. His life was forever changed as a result of abstinence only education, and yesterday he testified at the first ever Congressional oversight hearing on abstinence-only.

]]>This morning, I testified before the House Committee on Oversight and Government Reform in the first-ever hearing on abstinence-only-until-marriage sexuality education — a flawed policy that has transformed my life.

I testified as a 23-year-old living with HIV who has spent the last six years working to prevent new infections. I wanted to give a face to this $1.5 billion government-funded failure while explaining how the lessons I've learned apply to other young people, who now comprise 15 percent of all new HIV infections.

I experienced abstinence-only education taught by my junior high school gym teacher. He told me and my male classmates that sex is dangerous and that we should think more seriously about it when we "grow up and marry." He made clear that only heterosexuality ending in marriage should be discussed. Already aware of my sexual orientation, his speech might as well not have happened.

When I was 17, I began seeing someone six years older than me. The first time we had sex, I took out a condom but he ignored it. I did not know how to assert myself further. I knew enough to suggest a condom, but I didn't adequately understand the importance of using one, and even if had I understood that, I had no idea how to discuss condoms with my partner. The abstinence-only message did not prepare me for life, and I contracted HIV from the first person with whom I consented to have unprotected sex.

I was still in high school.

More individuals have this virus now than ever before in history. Most children born with HIV no longer die; they grow into adolescence and adulthood. Within and outside of marriage, these young people must know how to prevent transmission of HIV to their sexual partners and how to protect themselves. Instead, abstinence-only disparages HIV-positive youth by suggesting they are dirty, dying, and unfit for love.

While most abstinence-only programs are more extensive than the class I experienced, they rely on similarly exclusive and stigmatizing messages that lack basic information about sexual health. What I experienced is a routine example of the messages of abstinence-only that children across still experience today. These programs ignore lesbian, gay, bisexual, and transgender youth, who are at high risk for HIV, and use government dollars to condemn them. They also compromise young women's safety by portraying sexually active females as scarred and untrustworthy. From a healthcare perspective, it's essential that scrutiny of these programs focuses on the consequences of abstinence-only's condemnation of young people.

Editor's note: John Santelli, MD, MPH, will testify at the April 23, 2008, Hearing on Abstinence-Only Programs before the Committee on Oversight and Government Reform, U.S. House of Representatives. The following is excerpted from his testimony.

Numerous scientific and ethical critiques have been raised about abstinence-only education for young people. These concerns are articulated in reports by the Society for Adolescent Medicine, the American Public Health Association, and others.

Many abstinence-only programs withhold critical information or include misinformation, particularly about important health topics such as contraception and condoms. This puts young people at risk of sexually transmitted disease and unintended pregnancy. Such restrictions on health information are contrary to the medical ethical principle of informed consent and are a violation of human rights principles.

Demographic Trends

Evidence from the past several decades indicates that establishing abstinence until marriage as a normative behavior is a highly challenging policy goal. In 1970, there was a gap of only one and a half years between first sex and marriage; by 2002 this gap was a full eight years. Research has shown that over the past 40 years, the median age at first intercourse has dropped (and stabilized) at around age 17 in most developed countries. At the same time, the median age at marriage has risen dramatically. Thus, expecting people to wait until marriage to engage in sexual intercourse is increasingly unrealistic. Almost all Americans initiate sexual intercourse before marriage. By the time they reach age 44, 99 percent of Americans have had sex, and 95 percent have done so before marriage.

Trends in Adolescent Sexual Activity and Teen Pregnancy

Recent declines in teen sexual activity appear to be unrelated to federal abstinence programs. According to the Centers for Disease Control and Prevention, rates of sexual experience declined from 54 percent in 1991 to 46 percent in 2001 and have been unchanged since 2001. Note that much of the reduction in rates of adolescent sex occurred before the federal government began widespread funding of abstinence-only education in FY1998.

Two behaviors contribute directly to teen pregnancy: engaging in sexual intercourse and contraceptive use. From the 1960s through 1990, increasing involvement in sexual activity by teenagers in Western Europe and the United States was accompanied by sharply lower teen birth and pregnancy rates in most countries, due to greatly improved contraceptive use. Today, better use of contraceptives is the major behavioral difference between European and U.S. teenagers. Rates of sexual activity are similar, but European teens have much higher use of oral contraceptives and use of the "double Dutch" method-simultaneous use of condoms and hormonal methods.

Throughout the 1990s, teen sexual activity in the U.S. decreased and contraceptive use improved. Much of the improvement in contraceptive use was related to increasing condom use: between 1991 and 2001 condom use at last intercourse by young women rose from 38 percent to 51 percent. Increases in teen condom use in the 1980s were even more dramatic.

Among younger teens (15-17 years old), three-quarters of the decline was the result of improved contraceptive use. My colleagues and I have recently repeated this calculation for 1991 to 2003 using data from the Youth Risk Behavior Survey which is conducted nationwide with high schools students and found similar results. Improvements in contraceptive use between 1991 and 2003 were responsible for 70 percent of the decline in teen pregnancy.

Thus, while an increase in abstinence (i.e., fewer teens having sexual intercourse) explains some of the decline in teen pregnancy rates in the 1990s, more recently there appears to be little impact of abstinence on teen birth or pregnancy rates. Unfortunately these positive trends in contraceptive use reversed in 2005. Both no use of contraception and decreases in condom use occur in the most recent data. These reversals coincide with increases in teen birth rates in 2006 – after steady declines over the previous 14 years.

There is now an extensive body of research that demonstrates that comprehensive sexuality education programs that include information about both abstinence and contraception and share several other key characteristics, are effective in helping young people to delay the onset of sexual intercourse and to use contraception and/or condoms when they do have intercourse. Dr. Douglas Kirby conducted an analysis for the National Campaign to Prevent Teen and Unintended Pregnancy that examined well-designed studies and evaluated whether or not programs designed to reduce teen pregnancy and sexually transmitted infections, including HIV, actually worked in changing behavior. That meta-analysis shows compelling evidence that programs that include information on both abstinence and contraception and display a number of other characteristics are effective in helping young people to abstain or protect themselves from pregnancy and STDs.

In contrast, rigorous evaluations of abstinence-only programs find little evidence of efficacy for abstinence-only education. None of the well-designed evaluations of abstinence-only programs has presented strong evidence of an impact on behaviors.

The Mathematica evaluation of the Title V program, released in April 2007, found no measurable impact on increasing abstinence or delaying sexual initiation among participating youth or on other important health behaviors such as condom use. This well funded and well conducted evaluation examined four abstinence-only programs, tracking youth over four years. One of the few measurable impacts of the programs was a decrease in adolescent confidence regarding the ability of condoms to prevent HIV and other sexually transmitted diseases.

In other words, comprehensive sexuality education programs are actually better than abstinence-only programs at helping young people to abstain from sex.

Virginity Pledges

Virginity pledging, which is one approach to encouraging abstinence until marriage among youth, appears to have little long-term benefit in preventing outcomes such as sexually transmitted infections. A longitudinal study by Bruckner and Bearman found that teens who signed abstinence pledges, when compared to non-pledgers, experienced similar rates of sexually transmitted infection (Bruckner and Bearman, 2005). Pledgers did delay sexual intercourse for a limited period, but when they did start having sex, they were less likely to use condoms. They were also less likely to seek reproductive health care compared to non-pledgers leaving them at increased risk for unintended pregnancy and sexually transmitted infections.

House of Representatives' Committee on Government Reform Minority Staff found that 11 of the 13 most frequently used curricula contained false, misleading or distorted information about reproductive health – including inaccurate information about contraceptive effectiveness, purported health risks of abortion, and other scientific errors. Concerns about the accuracy of information included in abstinence-only programs have also been raised by many different professional organizations. Over the past several years, my colleagues and I at Columbia University have explored this issue. Our recent review of abstinence-only curricula found similar inaccuracies, particularly misinformation about the efficacy of condoms and contraception.

Ethical and Human Rights Concerns

As a physician, I am expected to provide information this is both accurate and complete to my patients. The premise of federal abstinence-only programs is antithetical to this basic principle of medical ethics. Abstinence-only programs require teachers and health educators to conceal information about risk reduction measures such as condoms and contraception-or risk loss of federal funding. Misinformation about condoms is of particular concern given the high rates of sexually transmitted diseases among young people in the United States.

For all of these reasons and more, the leading medical and health organizations in this country have taken the position that abstinence-only education is inappropriate for young people. On this panel you are hearing from two of the key organizations with concerns about abstinence-only approaches, the American Public Health Association and the American Academy of Pediatrics. Abstinence-only education is also opposed by the American Medical Association, the Society for Adolescent Medicine, the Institute of Medicine, and the American Foundation for AIDS Research.

Recommendations

As someone who is deeply committed to the well-being of young people, I urge the committee to encourage policies that will better serve the needs of America's youth.

Congress should develop policies to improve adolescent reproductive health based on sound scientific evidence and the realities of adolescents' lives. Policies should support what we know works in helping young people to stay healthy.

Congress should end federal support for abstinence-only programs that require withholding potentially life-saving information. Teachers should be allowed to teach. Indeed, policy makers have an ethical obligation to ensure that young people have the critical information they need to protect their health.

Congress should help ensure that every American adolescent has access to age appropriate, comprehensive sexuality education and comprehensive health care services to help young people to avoid HIV, other STDs and unplanned pregnancy. This approach is consistent with the scientific evidence about what works and echoes the overwhelming support of America's parents and physicians.

]]>http://rhrealitycheck.org/article/2008/04/22/congress-holds-hearings-on-abstinence-only/feed/7Scientists Tell Pelosi: No More Ab-only Fundinghttp://rhrealitycheck.org/article/2007/11/28/scientists-tell-pelosi-no-more-abonly-funding/?utm_source=rss&utm_medium=rss&utm_campaign=scientists-tell-pelosi-no-more-abonly-funding
http://rhrealitycheck.org/article/2007/11/28/scientists-tell-pelosi-no-more-abonly-funding/#commentsWed, 28 Nov 2007 08:09:00 +0000Ten leading scientists send an open letter to Congress urging them to discontinue funding for failed abstinence-only programs and offering to advise Congress on an alternative.

Editor's Note: This following letter was sent to Congresswoman Nancy Pelosi and Senator Harry Reid urging Congressional leaders to reconsider continuing federal investments in abstinence-only funding. The letter was sent by John S Santelli MD, MPH at Columbia University and signed by nine other prominent researchers in the field of adolescent sexual and reproductive health last Wednesday, Nov 21. It was sent to RH Reality Check yesterday and we are thrilled to post it below.

Dear Congresswoman Nancy Pelosi and Senator Harry Reid,

As a group of leading scientists who have recently conducted research on adolescents, reproductive health, and abstinence-only education, we are writing to express our strong concern about increasing federal support for abstinence-only education (AOE) programs. This federal support includes monies going to states (Section 510 of the Social Security Act) and those going directly to community and faith-based organizations (the Community-Based Abstinence Education program). Recent reports in professional publications by the authors of this letter have highlighted multiple deficiencies in federal abstinence-only programs. As such, we are surprised and dismayed that the Congress is proposing to extend and even increase funding for these programs. In this letter we identify key problems with abstinence-only education. We also have attached recent scientific reports that are pertinent to the debate over these programs. We note that many of these studies have used nationally-representative data from surveys sponsored by the National Institutes of Health or the Centers for Disease Control and Prevention.

The federal programs promoting AOE have prompted multiple scientific and ethical critiques. These critiques were summarized in a January 2006 paper by Santelli, Ott and others. By design, abstinence programs restrict information about condoms and contraception – information that may be critical to protecting the health of young people and to preventing unplanned pregnancy, HIV infection, and infection with other sexually transmitted organisms. They ignore the health needs of sexually active youth and youth who are gay, lesbian, bisexual, transgendered, and questioning for counseling, health care services, and risk reduction education. Withholding lifesaving information from young people is contrary to the standards of medical ethics and to many international human rights conventions. International treaties and human rights statements support the rights of adolescents to seek and receive information vital to their health. Governments have an obligation to provide accurate information to adolescents and adolescents have a right to expect health education provided in public schools to be scientifically accurate and complete.

Rigorous evaluations of AOE programs find little evidence of efficacy for federally-sponsored abstinence education. Several weeks ago Dr. Douglas Kirby, working with the National Campaign to Prevent Teen and Unplanned Pregnancy, released a comprehensive review of prevention programs for youth (Emerging Answers 2007). This review found that none of the well-designed evaluations of abstinence-only programs presented strong evidence of an impact on abstinence behaviors. (By contrast, Kirby finds clear evidence that many comprehensive sexuality education programs, which include information on both abstinence and contraception, do help young people delay initiation of intercourse.) The large-scale Mathematica evaluation of the Section 510 program, released in April 2007, found no measurable impact on increasing abstinence or delaying sexual initiation among participating youth or on other behaviors such as condom use. This well funded and very well conducted evaluation examined four exemplary local programs, tracking youth over four years. One of the few measurable impacts of the programs was a decrease in adolescent confidence regarding the ability of condoms to prevent HIV and other sexually transmitted diseases. Similar results on program efficacy were found by Underhill, who reviewed abstinence-only programs in a spring 2007 systematic review.

Virginity pledging, one aspect of abstinence programming, appears to have little long-term benefit in preventing outcomes such as sexually transmitted infections, although prevention of these infections is a stated goal of the programs. A spring 2005 longitudinal study by Bruckner and Bearman found that abstinence pledgers, when compared to non-pledgers, experienced similar rates of sexually transmitted infection. Pledgers did delay sexual intercourse for a limited period, but when they did start having sex, they were less likely to use condoms. They were also less likely to seek reproductive health care compared to non-pledgers.

Abstinence until marriage is another stated goal of the federal program; however, evidence from the past several decades indicates that establishing abstinence until marriage as normative behavior would be a highly challenging policy goal. Teitler has shown that over the past 40 years, the median age at first intercourse has dropped (and stabilized) to age 17 in most developed countries.

At the same time, the median age at marriage has risen dramatically. Today, sexual intercourse is almost universally initiated during adolescence worldwide. A January 2007 study by Finer found that almost all Americans initiate sexual intercourse before marriage. In fact by age 44, virtually everyone has experienced sexual intercourse but only 3% have remained abstinent until marriage. Moreover this is not a new trend; Finer's data suggest this pattern has been true for much of the second half of the 20th century.

Importantly, the emphasis on abstinence-only programs and policies appears to be undermining critical public health programs in the U.S. and abroad, including comprehensive sexuality education and HIV prevention programs. During the period of increased state and federal emphasis on abstinence, declines have occurred in the percentage of teachers in U.S. public schools who teach about birth control and the number of students who report receiving such education. In December 2006, Lindberg and colleagues found that the percentage of teenagers who had received formal instruction about condoms and contraception declined from 89% in 1995 to 70% in 2002.

We also note that a December 2004 Congressional report on federal abstinence programs from the U.S. House of Representatives' Committee on Government Reform – Minority Staff found that 11 of the 13 most frequently used curricula contained false, misleading or distorted information about reproductive health – including inaccurate information about contraceptive effectiveness, purported health risks of abortion, and other scientific errors. Recent reviews of these abstinence curricula from Santelli and colleagues at Columbia University have found similar inaccuracies, particularly misinformation about the efficacy of condoms and contraception. This was the basis of an ACLU declaration on this topic from Santelli in the spring of this year.

Abstinence-only requirements also appear to be harming our foreign aid efforts. In April 2006, the U.S. Government Accountability Office issued a report titled "Spending Requirement Presents Challenges for Allocating Prevention Funding under the President's Emergency Plan for AIDS Relief" that concluded that the "…requirement that country teams spend at least 33 percent of prevention funding appropriated pursuant to the act on abstinence-until-marriage programs has presented challenges to country teams' ability to adhere to the PEPFAR sexual transmission strategy…[and] challenged their ability to integrate the components of the ABC model and respond to local needs, local epidemiology, and distinctive social and cultural patterns."

The recent Congressional testimony of former Surgeon General Richard Carmona underscores these critiques from mainstream health organizations. Dr. Carmona's testimony confirms the political motivations behind abstinence funding and the failure to address issues of efficacy and scientific accuracy. He suggested that ideology and theology have taken priority over women's health in the current administration. Dr. Carmona reported that the Bush administration "did not want to hear the science but wanted to, if you will, ‘preach abstinence,' which I felt was scientifically incorrect."

Given these serious scientific and ethical shortcomings, we strongly urge the U.S. Congress to reconsider federal support for abstinence-only education programs and policies. We would be very willing to advise you on shaping alternatives to the current program.